Along with the low birth rate in Korea, the aging of mothers is progressing very rapidly. Recent studies have reported that the obstetric infrastructure is crumbling due to the accelerating closures of obstetric medical institutions resulting from the low birth rate and low reimbursement rates for obstetric procedures. The number of birth centers has also decreased, but women's interest in natural birth has actually increased, such that deliveries at birth centers now account for 11.8% of deliveries in obstetric clinics. In the Netherlands, Japan, and the United Kingdom, initiatives to promote natural birth through care provided by midwives increased the rate of natural births, decreased the number of cesarean sections, and lowered the rate of postpartum complications. In light of these examples, South Korea should also encourage natural delivery by midwives. A national support system for midwife applicants is necessary, and the requirements for institutions that train midwives should be revised. Independent birth centers should have emergency prescription privileges, and women should be given the choice to have a natural delivery by creating birth centers within hospitals.

Purpose: The purpose of this study was to analyze and synthesize the literature on intimate partner violence (IPV) against women in South Korea.
Methods: Whittemore and Knafl's integrative review method was used. Studies in English and Korean were searched in seven electronic databases using the following combination of terms: “Korea,” “females or women or girls,” “intimate partner violence or domestic violence or domestic abuse.”
Results: Twenty-five studies were ultimately selected, all of which met the quality appraisal criteria with a grade of medium or higher, using Gough's weight of evidence. IPV was divided into marital violence and dating violence. Factors related to IPV were classified into intrapersonal, interpersonal, and social factors, and these three factors were linked together. Intrapersonal factors included general characteristics, perceptions, attitudes, psychological factors, and violent experiences. Interpersonal factors involved relationships with parents and partners. Finally, social factors and attributes were integrated into social support and influences on life.
Conclusion: In order to minimize and prevent harm to women from IPV when caring for women who experienced IPV, multiple factors should be considered. Specifically, general and psychological characteristics, perceptions and attitudes toward IPV, relationships with families and partners, and available social support systems and resources should be considered. Moreover, these findings will be helpful for assessing women or providing interventions for victims of violence. Finally, more diverse IPV studies should be conducted by nurses in the future.

Purpose: The purpose of this study was to investigate the effects and characteristics of health care programs for pregnant women with gestational diabetes mellitus (GDM) in Korea.
Methods: This study was conducted according to the Cochrane Collaboration's systematic literature review handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. We searched eight international and domestic electronic databases for relevant studies. Two reviewers independently selected the studies and extracted data. For each study, information on the research method, participants, characteristics of the program, and results were extracted using a previously established coding table. The National Evidence-based Healthcare Collaborating Agency's risk of bias assessment tool for non-randomized studies was used to assess the risk of bias of the included articles. A qualitative review of the selected studies was performed because the interventions differed considerably and the measured outcomes varied.
Results: Out of 128 initially identified papers, seven were included in the final analysis. The risk of bias was evaluated as generally low. Health care programs for pregnant women with GDM showed positive effects on blood glucose control. Anxiety and depression were reduced, and self-management and self-care behavior, self-efficacy, and maternal identity improved.
Conclusion: Our study provides clinical evidence for the effectiveness of health care programs for pregnant women with GDM, and its results can be used to support the development of health care programs for GDM. More well-designed research is needed on GDM, especially studies that deal with emotional stress and apply a family-oriented approach.

Purpose: This systematic review aims to identify factors associated with risk-reducing salpingo-oophorectomy (RRSO), including the uptake rate and decision timing, among women at high risk for hereditary breast and ovarian cancer (HBOC).
Methods: We found 4,935 relevant studies using MEDLINE, Embase, CINAHL, and PsycINFO on July 6, 2020. Two authors screened the articles and extracted data. Twenty-four studies met the inclusion criteria. Quality assessment of articles was conducted using the Risk of Bias for Nonrandomized Studies tool.
Results: Five types of factors were identified (demographic factors, clinical factors, family history of cancer, psychological factors, and objective cancer risk). The specific significant factors were older age, having child(ren), being a BRCA1/2 carrier, mastectomy history, perceived risk for ovarian cancer, and perceived advantages of RRSO, whereas objective cancer risk was not significant. The uptake rate of RRSO was 23.4% to 87.2% (mean, 45.2%) among high-risk women for HBOC. The mean time to decide whether to undergo RRSO after BRCA testing was 4 to 34 months.
Conclusion: RRSO decisions are affected by demographic, clinical, and psychological factors, rather than objective cancer risk. Nonetheless, women seeking RRSO should be offered information about objective cancer risk. Even though decision-making for RRSO is a complex and multifaceted process, the psychosocial factors that may influence decisions have not been comprehensively examined, including family attitudes toward RRSO, cultural norms, social values, and health care providers' attitudes.

Purpose: Hysteroscopy can be used both to diagnose and to treat intrauterine pathologies. It is well known that hysteroscopy helps to improve reproductive outcomes by treating intrauterine pathologies. However, it is uncertain whether hysteroscopy is helpful in the absence of intrauterine pathologies. This study aimed to confirm whether hysteroscopy improves the reproductive outcomes of infertile women without intrauterine pathologies.
Methods: We conducted a systematic review of 11 studies retrieved from Ovid-MEDLINE, Ovid-Embase, and the Cochrane Library. Two independent investigators extracted the data and used risk-of-bias tools (RoB 2.0 and ROBINS-I) to assess their quality.
Results: Diagnostic hysteroscopy prior to in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) was associated with a higher clinical pregnancy rate (CPR) and live birth rate (LBR) than non-hysteroscopy in patients with recurrent implantation failure (RIF) (odds ratio, 1.79 and 1.46; 95% confidence interval, 1.40-2.30 and 1.08-1.97 for CPR and LBR, respectively) while hysteroscopy prior to first IVF was ineffective. The overall meta-analysis of LBR showed statistically significant findings for RIF, but a subgroup analysis showed effects only in prospective cohorts (odds ratio, 1.40 and 1.47; 95% confidence interval, 0.62-3.16 and 1.04-2.07 for randomized controlled trials and prospective cohorts, respectively). Therefore, the LBR should be interpreted carefully and further research is needed.
Conclusion: Although further research is warranted, hysteroscopy may be considered as a diagnostic and treatment option for infertile women who have experienced RIF regardless of intrauterine pathologies. This finding enables nurses to educate and support infertile women with RIF prior to IVF/ICSI.

Purpose: The purpose of this study was to identify the influence of self-differentiation, psychological discomfort, and marital dyadic adjustment on maternal-fetal attachment in primigravida.
Methods: In total, 108 primigravida participated in this descriptive correlational study. The participants answered self-report questionnaires. Data were collected from January to May, 2020, and were analyzed using descriptive statistics, the t-test, analysis of variance, Pearson correlation coefficients, and hierarchical multiple regression with SPSS for Windows ver. 23.0.
Results: The mean age of the primigravida was 31.66 years. The mean score for the degree of maternal-fetal attachment was 76.81 out of 96 points. Participants' scores for maternal-fetal attachment differed significantly based on age (t=2.08 p=.039) and marital status (t=2.05, p=.043). Maternal-fetal attachment was significantly negatively correlated with psychological discomfort (r=-.39, p<.001), and significantly positively correlated with self-differentiation (r=.36, p<.001) and marital dyadic adjustment (r=.36, p<.001). Self-differentiation explained 24.1% of variance in participants' maternal-fetal attachment, and its effect was statistically significant (F=7.79, p<.001).
Conclusion: In primigravida, more self-differentiation was associated with stronger maternal-fetal attachment. To strengthen maternal-fetal attachment in primigravidae, educational program that increases the level of self-differentiation and minimizes psychological discomfort may be helpful for first time pregnant women. Additionally, it is recommended to provide nursing interventions to encourage couples to work together throughout the gestational period.

Purpose: This study was conducted to evaluate the construct validity, reliability, measurement invariance, and latent mean differences in the Breastfeeding Adaptation Scale-Short Form (BFAS-SF) for use with mothers at 2 weeks postpartum.
Methods: This methodological study was designed to evaluate the validity, reliability, and measurement invariance of the BFAS-SF at 2 weeks postpartum, with data collected from 431 breastfeeding mothers. Confirmatory factor analysis and multi-group confirmatory factor analysis were conducted to assess the factor structure and the measurement invariance across employment status, delivery mode, parity, and previous breastfeeding experience, and the latent mean differences were then examined.
Results: The goodness of fit of the six-factor model at 2 weeks postpartum was acceptable. Multi-group confirmatory factor analysis supported strict invariance of the BFAS-SF across employment status and delivery mode. Full configural invariance, full metric invariance, and partial scalar invariance across parity and full configural invariance and full metric invariance across previous breastfeeding experience were supported, respectively. The results for latent mean differences suggested that mothers who were employed showed significantly higher scores for breastfeeding confidence. Mothers who had a vaginal delivery showed significantly higher scores for sufficient breast milk and baby's feeding capability. Multiparous mothers showed significantly higher scores for baby's feeding capability and baby's satisfaction with breastfeeding.
Conclusion: The validity and reliability of the BFAS-SF at 2 weeks postpartum are acceptable. It can be used to compare mean scores of breastfeeding adaptation according to employment status, delivery mode, and parity.

Purpose: This study aimed to identify factors influencing quality of life in post-menopausal women.
Methods: The participants were 194 post-menopausal women who visited a women's clinic in Changwon, Korea from July 1 to August 31, 2018, and completed questionnaires containing items on menopausal symptoms, marital intimacy, current menopausal hormone therapy (MHT), and quality of life. Collected data were analyzed by descriptive statistics, the independent t-test, Pearson correlation coefficients, and multiple regression using SPSS for Windows version 23.0.
Results: Quality of life had a significant negative correlation with menopausal symptoms (r=-.40, p<.001), and a significant positive correlation with marital intimacy (r=.54, p<.001). The factors influencing the quality of life of post-menopausal women were current MHT (t=6.32, p<.001), marital intimacy (t=4.94, p<.001), monthly family income (t=4.78, p<.001), menopausal symptoms (t=-4.37, p<.001), and education level (t=3.66, p<.001). These variables had an explanatory power of 59.2% for quality of life in post-menopausal women.
Conclusion: In order to improve the quality of life of post-menopausal women, nursing interventions are needed to help menopausal women choose appropriate MHT, alleviate menopausal symptoms, and increase marital intimacy. Interventions should also be prioritized for women of a low educational level and with a low income in consideration of their health problems.

Purpose: This descriptive phenomenological study aimed to explore the lived experience and meaning of pregnant women's adaptation.
Methods: Ten pregnant women from an ongoing Pregnant Couples' Cohort Study agreed to participate in this study. The data were collected through telephone in-depth interviews regarding what they experienced and felt about pregnancy adaptation. The qualitative data were analyzed using Giorgi's method of descriptive phenomenology.
Results: Five core situation components were extracted from the raw data, along with 12 themes and 33 focal meanings. The five core situations were 1) first recognizing the pregnancy, 2) pregnancy-related changes, (3) the upcoming birth, 4) the postpartum period, and 5) parenting. The 12 themes were as follows: “anxiety, pressure, and embarrassment due to pregnancy,” “efforts to adapt to physical changes,” “efforts to adapt to the psychological difficulties of pregnancy,” “efforts to adapt to the financial burden and role changes caused by pregnancy,” “connecting with the fetus,” “adapting to a new marital relationship centering on the baby,” “the frustration of childbirth,” “fear of childbirth,” “postpartum care, need help with lactation planning,” “parenting beyond what I imagined,” “dad's willingness to participate in parenting,” and “career disconnect and consideration of workplace needs.”
Conclusion: We identified that pregnant women experience adaptation in physical, psychological, relational, and social aspects. The thematic clusters identified can be used to develop nursing interventions to promote women's adaptation to pregnancy.